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Background: Histopathologic features of interface dermatitis can occasionally be seen in mycosis fungoides (MF), particularly in early patch-stage disease. Materials and Methods: We identified six patients with MF whose early biopsy specimens showed such prominent interface dermatitis that a benign diagnosis was favored. All subsequent specimens were reviewed for these patients, and the histopathologic evolution of disease was documented. Immunohistochemistry (IHC) for CD2, CD3, CD4, CD5, CD7, CD8, CD30, and CD123 was performed retrospectively. Educational archives were reviewed to assess the incidence of interface dermatitis in biopsies otherwise diagnostic of MF. Results: A spectrum of vacuolar and lichenoid patterns of interface change was observed in this series of six patients eventually diagnosed as having MF, and was seen as a recurring pattern in multiple specimens over time. In retrospect, findings described in early MF such as lining up of lymphocytes along the dermal--epidermal junction within the basal layer, papillary dermal fibrosis, and intraepidermal lymphocyte atypia could be appreciated to varying degrees in the confounding specimens. CD123 was negative in all cases, putatively excluding a connective tissue disease (CTD). None of the early biopsies showed loss of pan-T antigens CD2, CD5, and CD7. Forty-six of 164 cases (28%) of MF in an archival study set showed varying degrees of interface dermatitis in the setting of otherwise diagnostic changes of MF. Conclusions: Early MF can show prominent interface change and mimic inflammatory dermatoses. Histopathologic clues suggestive of MF should be carefully assessed, and IHC for CD123 may be helpful in distinguishing MF from CTD. Repeat biopsies over time may be necessary to arrive at a definitive diagnosis, in conjunction with ancillary studies and strong clinicopathologic correlation. [ABSTRACT FROM AUTHOR]

Purpose of Review: This article aims to review the challenges in axial spondyloarthritis diagnosis and identify the possible contributing factors. Recent Findings: The inability to reach an accurate diagnosis in a timely fashion can lead to treatment delays and worse disease outcomes. The lack of validated diagnostic criteria and the misuse of the currently available classification criteria could be contributing. There is also significant inter-reader variability in interpreting images, and the radiologic definitions of axial spondyloarthritis continue to be re-defined to improve their positive predictive value. The role of inflammatory back pain features, serologic biomarkers, genetics, and their diagnostic contribution to axial spondyloarthritis continues to be investigated. Summary: There is still a significant amount of delay in the diagnosis of axial spondyloarthritis. Appreciating the factors that contribute to this delay is of utmost importance to close the gap. It is similarly important to recognize other conditions that may present with symptoms that mimic axial spondyloarthritis so that misdiagnosis and wrong treatment can be avoided. [ABSTRACT FROM AUTHOR]

Abstract Background Juvenile idiopathic arthritis is the most common chronic rheumatic disease of childhood. The term JIA encompasses a heterogenous group of diseases. The variability in phenotype of patients affected by the disease means it is not uncommon for mimics of JIA to be misdiagnosed. Case presentation We present four cases who were treated in single tertiary rheumatology centre for JIA who were subsequently diagnosed with a rare monogenic disease. All four patients shared the unifying features of presenting in early childhood and subsequently suffered with refractory disease, not amenable to usual standards of treatment. Multicentric Carpotarsal Osteolysis Syndrome and Camptodactyly-arthropathy-coxa vara-pericarditis syndrome are non-inflammatory conditions and patients typically present with arthropathy, normal inflammatory markers and atypical radiological features. Blau syndrome is an autosomal dominant condition and patients will typically have symmetrical joint involvement with a strong family history of arthritis, signifying the genetic aetiology. Conclusions We share our learning from these cases to add to the growing portfolio of JIA mimics and to highlight when to consider an alternative diagnosis. In cases of refractory disease and diagnostic uncertainty further imaging and genetic testing can play a crucial role in establishing the aetiology. In all of these cases the correct diagnosis was made due to careful, longitudinal clinical phenotyping and a close working relationship between rheumatology, radiology and clinical genetics; highlighting the importance of the multidisciplinary team in managing complex patients.

Objective: This study aimed to evaluate the pattern of presentation of infectious lesions mimicking malignancy. This will serve to heighten clinical indices of suspicion and prevent unwarranted aggressive management. Methods: This is a 19-year (1999-2017) audit review of all morphologically diagnosed infection-related lesions in which malignancy was primarily clinically suspected. Results: Fifty-six cases of infection-related mimics of malignancy were diagnosed in the study period: schistosomiasis related, 22 (39.2%); actinomycosis, 21(37.5%); tuberculosis-related, 10 (17.9%); fungi-related, 3(5.4%). Twenty-one cases of actinomycosis of the lower limbs and oropharynx were mistaken for melanoma, squamous cell carcinoma, sarcoma, and oropharyngeal carcinoma. The mean age was 33±17years.The 10 patients with atypical Mycobacterium tuberculosis-mimicking malignancy had mean age of 37±14 years and included three in the testes, testicular cases, one from the jaw, and two cases each from ovary, breast, and uterus. Of the three fungal lesions, there was a case each from the brain, skin, and bone. All were males with mean age of 21±7 years. Conclusion: For accurate diagnosis of infection-related mimics of malignancy, a high index of clinical suspicion, knowledge of and attention to characteristic radiological signs, and obtaining representative tissues for histopathologic and cytopathologic diagnoses are paramount.

ObjectiveThe purposes of this article are to review a variety of pitfalls in liver imaging that can lead to the inaccurate diagnosis of focal hepatic lesions in cirrhosis, to describe the pathophysiologic processes of these pitfalls, and to provide specific clues for achieving the correct diagnoses.ConclusionCirrhosis complicates liver imaging. The distortion and replacement of normal liver parenchyma by fibrous and regenerative tissue can change the typical appearance of many benign lesions, causing them to be misinterpreted as malignancy. In addition, the high incidence and prevalence of hepatocellular carcinoma among patients with cirrhosis put radiologists on high alert for any suspicious findings, especially because not all hepatocellular carcinomas have a typical imaging appearance.

BACKGROUND: There are few articles on the treatment of lumbar spinal stenosis by unilateral two-channel endoscopic contralateral approach, and there is no in-depth analysis of the endoscopic location, decompression scope and adjacent relationship of various structures of this approach. OBJECTIVE: To observe the bony structure, nerve tissue, intervertebral space, attachment of ligamentum flavum and position of lumbar isthmus in lateral recess and foraminal area through three-dimensional CT imaging. METHODS: Totally 34 patients with lumbar spinal stenosis admitted to the Affiliated Hospital of Binzhou Medical College from June 2019 to July 2021 were enrolled. Lumbar CT myelography was performed before surgery, and the images were imported into Mimics 21.0 software to reconstruct lumbar threedimensional CT model. Relevant parameters of L4/5 and L5S1 segments were measured: (1) The vertical distance from the intersection of the lumbar spinous process and the lower edge of the lamina (Q) to the lower edge of the contralateral same lumbar pedicle (a), the upper edge of the contralateral pedicle of the lower lumbar spine (b), the lower endplate of same lumbar (c), the upper endplate of lower lumbar vertebrae (d); (2) The vertical distance from superior articular process to the upper edge of same lumbar pedicle (e), the lower endplate of upper lumbar vertebrae (f); (3) The vertical distance from the lower endplate of lumbar vertebrae to the lower edge of the contralateral lumbar pedicle (g); (4) The vertical distance from the upper endplate of lumbar vertebrae to the upper edge of the same lumbar pedicle (h); (5) The vertical distance from the lower edge of the nerve root origin to the lower edge of the upper lumbar pedicle (i), the upper edge of the lower lumbar spine pedicle (j); (6) A 3 mm diameter guide rod was established through point Q and the lower edge of the contralateral same lumbar pedicle to measure the abduction angle of guide rod (k). Seven patients underwent unilateral biportal endoscopic lumbar decompression through the contralateral approach. The effect of surgery was verified by visual analog scale score, Oswestry disability index, and short form-36 health survey. RESULTS AND CONCLUSION: (1) The Q points and the upper margin of ligamentum flavum could be used as important localization markers under the endoscopy. The upper margin of the ligamentum flavum was used to locate the exiting nerve root, the upper edge of the foramina, the lumbar isthmus and the inferior articular process. The level of 1/3 of the contralateral foramen of L4/5 and the vicinity of L4 inferior endplate could be reached by Q point perpendicular to the posterior midline of spinous process, and then decompress the lateral recess at the level of the disc. (2) The lower edge of L5 nerve root origin was mostly projected at the level of L4/5 lower 1/3 of the foramen, and it was consistent with the L4/5 intervertebral projection, suggesting that the L5 walking nerve roots were mostly compressed near the level of the L4/5 disc. (3) The Q point, the lower edge of S1 nerve root origin and the L5 the exiting nerve root all corresponded to the level of the upper 1/3 of the L5S1 intervertebral foramen, and the corresponding lateral recess with dense nerve tissue in this area should be prudently decompressed. (4) The intervertebral spaces of L4/5 and L5S1 were projected near the level of the lower 1/3 of the same segment intervertebral foramen and under the Q point. The operation channel should be decompressed through Q point level with moderate tail tilt. (5) When removing the hyperplastic superior facet osteophytes of L4/5 and L5S1, the superior facet should be retained at approximately normal height to avoid affecting the stability of lumbar spine. (6) All seven patients with contralateral approach surgery successfully completed the operation, and the follow-up time was 6-12 months. With the prolongation of postoperative rehabilitation time, the visual analog scale score and Oswestry disability index were significantly lower than those before surgery, and the score of short form-36 health survey was significantly improved than that before surgery. (7) It is suggested that the results of this study can guide unilateral biportal endoscopy for lumbar spinal stenosis through contralateral approach. [ABSTRACT FROM AUTHOR]

Multiple system atrophy (MSA) is a sporadic and progressive neurodegenerative disorder with a complex differential diagnosis. A range of disorders— also of nondegenerative etiology— can mimic MSA, expanding its differential diagnosis. Both misdiagnosis and diagnostic delays are relatively common in clinical practice. A correct diagnosis is vital for daily clinical practice, in order to facilitate proper counselling and to timely install therapies in treatable disorders that mimic MSA. A correct diagnosis is also essential for including properly classified individuals into research studies that aim to better understand the pathophysiology of MSA, to develop specific biomarkers or to evaluate novel symptomatic or disease-modifying therapies. Here, we offer some practical guidance to support the diagnostic process, by highlighting conditions that may be considered as MSA lookalikes, by emphasizing some key clinical aspects of these mimics, and by discussing several useful ancillary diagnostic tests. [ABSTRACT FROM AUTHOR]

Precise blood pressure (BP) estimation is vital for diagnosing arterial hypertension and other cardiovascular ailments. The photoplethysmogram (PPG)-based cuff-less BP measurement is an alternative to the traditional cuff-based systems. The morphological, temporal, and frequency-domain-based features have been used for BP estimation in the PPG-based BP measurement systems. However, dealing with varying signal morphology and feature dependency on the fiducial points in PPG contours remains challenging and limits the performance of the existing BP estimation algorithms, especially in wearable devices. This work presents a novel approach that considers the nonlinear features of PPG signals evaluated using higher order derivatives. In particular, the PPG signal’s third and fourth derivative contours are used to extract features, such as fractal dimension, bubble entropy (BE), Lyapunov exponent, and moving slope. Machine learning algorithms such as random forest (RF), extreme gradient boosting (XGBoost), and support vector regression (SVR) models are used for BP estimation using the nonlinear features of PPG signals. The estimated BP values are further categorized based on five broad classes based on the BP stratification criteria such as hypotension, normal, prehypertension, stage-I, and stage-II hypertension, respectively. The performance of the suggested approach is evaluated using PPG signals from three publicly available databases (multiparameter intelligent monitoring in intensive care (MIMIC)-I, II, and III). The proposed estimation approach has outperformed the recent existing algorithms and achieved a minimum value of mean absolute error (MAE) ± standard deviation (STD) in (systolic BP (SBP) and diastolic BP (DBP) values) as ${0}.{74}\pm {2}.{42}$ and ${0}.{35} \pm {1}.{06}$ , respectively, for the MIMIC-I database. The suggested approach has also achieved grade-A on the British Hypertension Society (BHS) standard. [ABSTRACT FROM AUTHOR]

Cryptococcoid Sweet syndrome is a rare histologic variant of the neutrophilic dermatosis presenting clinically with skin lesions typical of classical Sweet syndrome but with yeast-like structures suggestive of C ryptococcus on histopathology. Histochemical stains for fungus and cultures are negative whereas staining for myeloperoxidase is positive. We present 2 cases of cryptococcoid Sweet syndrome with atypical skin manifestations, including hemorrhagic bullae and plaques, and provide a brief review of the literature. Clinicians should be aware that this variant of Sweet syndrome can present with uncommon clinical findings and has histopathologic findings suggestive of Cryptococcus species. [ABSTRACT FROM AUTHOR]

Experimental studies of biotic interactions in real field conditions are essential to understand the structure and functioning of ecological networks. The use of artificial caterpillars to mimic actual prey availability is generally seen as a standard approach to compare the activity and diversity of predators along environmental gradients. Yet, even with standardized material and procedures, biases may still affect data from multiple observers with different expertise. We used pictures of artificial caterpillars with or without various predation marks, in an online survey that was targeted for the participants of the project, to evaluate the reliability of predation marks identification made by non‐scientists and by scientists with and without experience in predation mark identification. Pictures of artificial caterpillars displayed typical marks left by birds, mammals, and arthropods, as well as non‐predation marks ('false positive'). In total 357 respondents scanned 7140 pictures of artificial caterpillars. Scientists were more confident and accurate in their observations than non‐scientists, but the differences in correct identifications among scientists and non‐scientists were low. Scientists with experience were also more accurate than scientists without experience, whereas there were no differences in self‐confidence among scientists with and without experience. Accuracy in predation mark identification did not differ among types of predators, but respondents were more keen to identify marks left by birds or mammals than marks left by arthropods. Our results have practical implications for the design of multi‐observer projects relying on artificial caterpillars as a proxy to assess predation intensity, in particular in the context of citizen science. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to investigate the influence of the periapical lesion size on healing outcome following Regenerative Endodontic Procedures (REPs) in mature teeth using cone-beam computed tomography (CBCT) and Mimics software. Methods: The study included ten mature necrotic maxillary anterior teeth with periapical lesions ≥ 3 CBCT Periapical index score (CBCTPAI). REPs via blood clots were performed for all the teeth. CBCT scans were taken pre and postoperatively after 12 months follow-up periods and transferred to Mimics for volume measurements and comparison. Statistical analysis was performed using the Wilcoxon signed-rank test. Result: All teeth were symptom-free with a statistically significant decrease in the volume of the periapical lesion (P < 0.05) after 12 months except for one case. Conclusion: The study concluded that REPs could be a successful treatment modality for mature necrotic teeth with periapical lesions however the size of the preoperative periapical lesion could affect the outcome of the periapical healing. Trial registration: The study was registered in ClinicalTrials.gov (ID: NCT04646538). [ABSTRACT FROM AUTHOR]

The International Classification of Diseases (ICD) code is a disease classification method formulated by the World Health Organization(WHO). ICD coding usually requires clinicians to manually allocate ICD codes to clinical documents, which is labor-intensive, expensive, and error-prone. Therefore, many methods have been introduced for automatic ICD coding. However, most of the methods have ignored or cannot combine two essential features well: long-tailed label distribution and label correlation. In this paper, we propose a novel end-to-end Joint Attention Network (JAN) to solve these two problems. JAN includes Document-based attention and Label-based attention to capture semantic information from clinical document text and label description, respectively, which helps solve the classification of dense and sparse data in long-tailed label distribution. Besides, an Adaptive fusion layer and CorNet block are presented to adaptively adjust the weight of these two attentions and exploit label co-occurrence relations, respectively. Experiments on the MIMIC-III and MIMIC-II datasets demonstrate that our proposed JAN outperformed previous state-of-art methods achieving Micro-F1 of 0.553, Micro-AUC of 0.989 and precision at top 8(P@8) of 0.735. Finally, we also provide attention and label correlation visualization to verify the effectiveness of our model and improve the interpretation of our deep learning-based method. [ABSTRACT FROM AUTHOR]

Non-negative tensor factorization has been shown a practical solution to automatically discover phenotypes from the electronic health records (EHR) with minimal human supervision. Such methods generally require an input tensor describing the inter-modal interactions to be pre-established; however, the correspondence between different modalities (e.g., correspondence between medications and diagnoses) can often be missing in practice. Although heuristic methods can be applied to estimate them, they inevitably introduce errors, and leads to sub-optimal phenotype quality. This is particularly important for patients with complex health conditions (e.g., in critical care) as multiple diagnoses and medications are simultaneously present in the records. To alleviate this problem and discover phenotypes from EHR with unobserved inter-modal correspondence, we propose the collective hidden interaction tensor factorization (cHITF) to infer the correspondence between multiple modalities jointly with the phenotype discovery. We assume that the observed matrix for each modality is marginalization of the unobserved inter-modal correspondence, which are reconstructed by maximizing the likelihood of the observed matrices. Extensive experiments conducted on the real-world MIMIC-III dataset demonstrate that cHITF effectively infers clinically meaningful inter-modal correspondence, discovers phenotypes that are more clinically relevant and diverse, and achieves better predictive performance compared with a number of state-of-the-art computational phenotyping models. [ABSTRACT FROM AUTHOR]

Purpose: Magnetic resonance imaging (MRI) findings in multiple sclerosis (MS) overlap with numerous MS mimics. The central vein sign (CVS) can help to differentiate MS from other mimics. This study aimed to determine the value of CVS as a diagnostic biomarker for distinguishing MS from its mimics. Patients and Methods: Patients were prospectively recruited into two groups: a typical clinical (TC) MS presentation with an atypical MRI for MS and an atypical clinical (ATC) MS presentation with a typical MRI for MS. Patients underwent a 1.5T MRI brain scan with a T2*-weighted gradient-echo sequence. The presence of the central vein was assessed by a radiologist blinded to patients' clinical presentation. The MS consultant made the final diagnosis without reviewing the T2*-weighted gradient-echo sequence or the CVS analysis results. Results: Forty-two patients were included. Ten (40%) out of 25 TC patients were diagnosed with clinically definite MS (CDMS), with a mean percentage of CV-positive lesions of 65.5% among CDMS patients. Four (23.5%) out of 17 ATC patients were diagnosed with CDMS with a mean CV-positive lesions percentage of 68.25% among CDMS patients. TC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 10.13%, while ATC patients who were not diagnosed as CDMS had a mean CV-positive lesions percentage of 16.38%. The CVS showed 85.7% sensitivity and 100% specificity (95% confidence interval: 0.919– 1.018) for diagnosis of MS at a cut off value of 45% (p < 0.001). The percentage of CV-positive lesions was significantly higher in oligoclonal bands (OCBs) positive patients compared to OCBs negative patients (p < 0.001) and those with spinal cord lesions compared to patients with no spinal cord lesions (p = 0.017). Conclusion: The CVS has 85.7% sensitivity and 100% specificity for the diagnosis of MS at a cutoff value of 45%. [ABSTRACT FROM AUTHOR]

Future smart grids represent interdependent cyber-physical systems that involve multiple interactions between a power grid and a communication network. Such a mutual dependence increases the risk of large-scale cascading failures. Thus, it is important to conduct a joint vulnerability analysis. Unfortunately, existing works failed to identify the combination of power nodes and communication nodes that present the greatest damage impact. In this article, we first present a model that captures the interdependence between the two subsystems using stochastic geometry; then, we conduct a joint vulnerability analysis. We propose an attack strategy that targets the most influential nodes in both subsystems. We show that, based on six joint targeted nodes, this strategy presents a comparable and, in some cases, larger damage impact compared to the traditional exhaustive search attack and with very low complexity. Our investigations reveal that 1) the proposed joint attack strategy presents a large damage impact at a significantly small simulation runtime and 2) attacking the most influential communication nodes solely or the most influential power nodes solely achieves a comparable damage impact to that of the proposed joint attack. [ABSTRACT FROM AUTHOR]

Nasal tip mechanical stability is important for functional and cosmetic nasal airway surgery. Palpation of the nasal tip provides information on tip strength to the surgeon, though it is a purely subjective assessment. Providing a means to simulate nasal tip deformation with a validated model can offer a more objective approach in understanding the mechanics and nuances of the nasal tip support and eventual nasal mechanics as a whole. Herein we present validation of a finite element (FE) model of the nose using physical measurements recorded using an ABS plastic-silicone nasal phantom. Three-dimensional photogrammetry was used to capture the geometry of the phantom at rest and while under steady state load. The silicone used to make the phantom was mechanically tested and characterized using a linear elastic constitutive model. Surface point clouds of the silicone and FE model were compared for both the loaded and unloaded state. The average Hausdorff distance between actual measurements and FE simulations across the nose were 0.39 ± 1.04 mm and deviated up to 2 mm at the outermost boundaries of the model. FE simulation and measurements were in near complete agreement in the immediate vicinity of the nasal tip with millimeter accuracy. We have demonstrated validation of a two-component nasal FE model, which could be used to model more complex modes of deformation where direct measurement may be challenging. This is the first step in developing a nasal model to simulate nasal mechanics and ultimately the interaction between geometry and airflow.

Abstract SARS‐CoV‐2 viral infection led to the devastating COVID‐19 pandemic, where illness stemmed from interactions between virions and recipient host cells resulting in multi‐layered pathological consequences. The role of the infection portal is now understood to be the cellular angiotensin converting enzyme‐2 (ACE2) receptor, which binds to viral spike (S) protein initiating virion internalisation process. Since SARS‐CoV‐2 virions bear some resemblance to endogenously produced small extracellular vesicles (sEVs) we reasoned that EVs engineered to express S protein (viral mimics) may interfere with viral infection. Here, we report generation of HEK293T cells producing sEVs enriched for transmembrane S‐protein tagged with green fluorescent protein (S/GFP). Strikingly, S protein drove the GFP tag to the membrane of sEVs, while GFP alone was not efficiently included in the sEV cargo. High‐throughput quantitative proteomics revealed that S/GFP sEVs contained over 1000 proteins including canonical components of the exosomal pathway such as ALIX, syntenin‐1, and tetraspanins (CD81, CD9), but depleted for calnexin and cytochrome c. We found that 84 sEV proteins were significantly altered by the presence of S/GFP. S protein expressing EVs efficiently adhered to target cells in an ACE2‐dependent manner, but they were poorly internalised. Importantly, prolonged administration of S/GFP EV to K18‐hACE2 mice provided a significant protection against SARS‐CoV‐2 infection. Thus, the generation of sEV containing S protein can be considered as a novel therapeutic approach in reducing the transmission of SARS‐CoV‐2.

Abstract Batesian mimicry may result in remarkable cases of phenotypic convergence that represent classic examples of evolution through natural selection. The existence of mimicry systems among coral snakes, however, remains controversial because of contradictions between the predictions of mimetic theory and the empirical patterns of co-occurrence and species abundance. Here, we analyze the geographic distribution of coral snake species of the genus Micrurus and populations of the false coral snake Atractus latifrons in Amazonia, and perform ecological niche modeling (ENM) analyzes to generate potential geographic distributions of species of Micrurus and A. latifrons, identify patterns of co-occurrence and assess whether the distribution of A. latifrons coincides with the distribution of Micrurus species, which could suggest the existence of a possible mimetic relationship between the species. We identified six Micrurus species that may represent mimetic models for A. latifrons. The results of the co-occurrence analysis corroborates the results from ENM, indicating that chromatic patterns of A. latifrons and their respective model species are aggregated. Our study suggests that all color patterns of A. latifrons – including the tricolor monads, and the more common tricolor dyads and tricolor tetrads – may benefit from the resemblance with other Micrurus species as perfect and imperfect mimics.

Colubrids represent a diverse group of snakes historically regarded as harmless. With over 300 genera, the Colubridae family is the largest, encompassing approximately two-thirds of extant snake species. We describe a case of an 18-year-old male who suffered a colubrid snakebite from Erythrolamprus bizona , commonly known as the double-stranded coral snake mimic or false coral snake, which he misidentified as Lampropeltis sp., a fangless colubrid snake. Patient experienced localized erythema and edema, which later spread to the entire left hand along with moderate pain. Laboratory tests revealed leukocytosis and elevated creatine kinase. Symptoms resolved one week later. This case highlights the public health significance of ophidian accidents due to apparently "non-venomous snakes" or low-risk snakes such as the opisthoglyphous colubrid E. bizona. It also underscores the need to correctly identify and differentiate these snakes from other harmless colubrids, particularly double-stranded coral snake mimics in areas of geographic overlap and avoid their manipulation if uncertain of their taxonomic status. [ABSTRACT FROM AUTHOR]

Objectives: COVID-19 is a transmissible illness triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its onset in late 2019 in Wuhan city of China, it continues to spread universally, leading to an ongoing pandemic that shattered all efforts to restrain it. On the other hand, in Africa, the COVID-19 infection may be influenced by malaria coinfection. Hence, in this review article, we aimed to give a comprehensive account of the similarities between COVID-19 and malaria in terms of symptoms, clinical, immunological, and molecular perspectives. Methodology: In this article, we reviewed over 50 research papers to highlight the multilayered similarities between COVID-19 and malaria infections that might influence the ontology of COVID-19. Results: Despite the poor health and fragile medical system of many sub-Saharan African countries, they persisted with a statistically significantly low number of COVID-19 cases. This was attributed to many factors such as the young population age, the warm weather, the lack of proper diagnosis, previous infection with malaria, the use of antimalarial drugs, etc. Additionally, population genetics appears to play a significant role in shaping the COVID-19 dynamics. This is evident as recent genomic screening analyses of the angiotensin-converting enzyme 2 (ACE2) and malaria-associatedvariants identified 6 candidate genes that might play a role in malaria and COVID-19 incidence and severity. Moreover, the clinical and pathological resemblances between the two diseases have made considerable confusion in the diagnosis and thereafter curb the disease in Africa. Therefore, possible similarities between the diseases in regards to the clinical, pathological, immunological, and genetical ascription were discussed. Conclusion: Understanding the dynamics of COVID-19 infection in Sub-Saharan Africa and how it is shaped by another endemic disease like malaria can provide insights into how to tailor a successful diagnostic, intervention, and control plans that lower both disease morbidity and mortality. [ABSTRACT FROM AUTHOR]

Endometrial stromal sarcoma (ESS) is a rare uterine neoplasm infrequently arising in extra-genital sites. Herein, we report an extremely rare case of primary extra-genital ESS of transverse mesocolon occurring in a 51-year-old female presenting with gradually increasing abdominal mass. The clinical diagnosis considered was a gastrointestinal stromal tumor. Intra-operatively, the mass was confined exclusively to the transverse mesocolon. Microscopy revealed a cellular tumor composed of oval to elongate neoplastic cells with hyperchromatic nuclei, inconspicuous nucleoli and were immunoreactive for CD10, progesterone receptor (PR), estrogen receptor (ER), and PAX8; negative for KIT, CD34, SMA, S100, synaptophysin, chromogranin, WT1, and calretinin. A distinct arborizing network of arterioles along with foci of endometriosis was also seen. We present this case for its extreme rarity and the challenges entailed in its diagnosis. [ABSTRACT FROM AUTHOR]

Background: Juvenile idiopathic arthritis is the most common chronic rheumatic disease of childhood. The term JIA encompasses a heterogenous group of diseases. The variability in phenotype of patients affected by the disease means it is not uncommon for mimics of JIA to be misdiagnosed. Case presentation: We present four cases who were treated in single tertiary rheumatology centre for JIA who were subsequently diagnosed with a rare monogenic disease. All four patients shared the unifying features of presenting in early childhood and subsequently suffered with refractory disease, not amenable to usual standards of treatment. Multicentric Carpotarsal Osteolysis Syndrome and Camptodactyly-arthropathy-coxa vara-pericarditis syndrome are non-inflammatory conditions and patients typically present with arthropathy, normal inflammatory markers and atypical radiological features. Blau syndrome is an autosomal dominant condition and patients will typically have symmetrical joint involvement with a strong family history of arthritis, signifying the genetic aetiology. Conclusions: We share our learning from these cases to add to the growing portfolio of JIA mimics and to highlight when to consider an alternative diagnosis. In cases of refractory disease and diagnostic uncertainty further imaging and genetic testing can play a crucial role in establishing the aetiology. In all of these cases the correct diagnosis was made due to careful, longitudinal clinical phenotyping and a close working relationship between rheumatology, radiology and clinical genetics; highlighting the importance of the multidisciplinary team in managing complex patients. [ABSTRACT FROM AUTHOR]

The interpretation of medical images is a fundamental process for the diagnosis and treatment of patients. This process contributes determining the causes of symptoms as well as monitoring the effects of any treatment. Although the generation of medical reports from images is a complex task, deep learning strategies have been integrated with models that allow this arduous task to be tackled, achieving promising results. This work aims to present a compilation of the most outstanding deep learning strategies focused on the automatic generation of medical radiology reports from X-Ray images. Papers based on DenseNet, ResNet and VGG architectures, in combination with Long Short-Term Memories (LSTMs) and attention models, are analyzed in terms of the pre-processing strategies, databases used, model adaptations, and metric results. All these important findings are summarized in this survey, highlighting those models that reported the highest performance. [ABSTRACT FROM AUTHOR]

ObjectivesCOVID-19 is a transmissible illness triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its onset in late 2019 in Wuhan city of China, it continues to spread universally, leading to an ongoing pandemic that shattered all efforts to restrain it. On the other hand, in Africa, the COVID-19 infection may be influenced by malaria coinfection. Hence, in this review article, we aimed to give a comprehensive account of the similarities between COVID-19 and malaria in terms of symptoms, clinical, immunological, and molecular perspectives.MethodologyIn this article, we reviewed over 50 research papers to highlight the multilayered similarities between COVID-19 and malaria infections that might influence the ontology of COVID-19.ResultsDespite the poor health and fragile medical system of many sub-Saharan African countries, they persisted with a statistically significantly low number of COVID-19 cases. This was attributed to many factors such as the young population age, the warm weather, the lack of proper diagnosis, previous infection with malaria, the use of antimalarial drugs, etc. Additionally, population genetics appears to play a significant role in shaping the COVID-19 dynamics. This is evident as recent genomic screening analyses of the angiotensin-converting enzyme 2 (ACE2) and malaria-associated-variants identified 6 candidate genes that might play a role in malaria and COVID-19 incidence and severity. Moreover, the clinical and pathological resemblances between the two diseases have made considerable confusion in the diagnosis and thereafter curb the disease in Africa. Therefore, possible similarities between the diseases in regards to the clinical, pathological, immunological, and genetical ascription were discussed.ConclusionUnderstanding the dynamics of COVID-19 infection in Sub-Saharan Africa and how it is shaped by another endemic disease like malaria can provide insights into how to tailor a successful diagnostic, intervention, and control plans that lower both disease morbidity and mortality.

AbstractMimics account for almost half of hospital admissions for suspected stroke. Stroke mimics may present as a functional (conversion) disorder or may be part of the symptomatology of a neurological or medical disorder. While many underlying conditions can be recognized rapidly by careful assessment, a significant proportion of patients unfortunately still receive thrombolysis and admission to a high-intensity stroke unit with inherent risks and unnecessary costs. Accurate diagnosis is important as recurrent presentations may be common in many disorders. A non-contrast CT is not sufficient to make a diagnosis of acute stroke as the test may be normal very early following an acute stroke. Multi-modal CT or magnetic resonance imaging (MRI) may be helpful to confirm an acute ischaemic stroke and are necessary if stroke mimics are suspected. Treatment in neurological and medical mimics results in prompt resolution of the symptoms. Treatment of functional disorders can be challenging and is often incomplete and requires early psychiatric intervention.

Proximal muscle weakness in children, as well as adults, can be the presenting feature of a wide range of diseases including but not limited to the idiopathic inflammatory myopathies, muscle dystrophies, metabolic, endocrine, and drug-induced myopathies. Certain diagnostic clues such as selective muscle involvement in inherited dystrophies, cramping on exertion in metabolic myopathies, diffuse muscular pain in endocrinal myopathies, and relevant drug history along with a lack of appropriate treatment response to steroids should be considered. Awareness of other possibilities and a keen eye to identify the mimics may avoid diagnostic delays and allow timely treatment. In this review, we cover some of the salient features of the various myositis mimics and the pertinent investigation findings as well as gray areas which may confound recognition of the underlying etiology. Later, we discuss key features of certain mimics while providing an overview of the differential diagnosis and clinical management for treating clinicians.

Aim and Objective : Our study was an observational and evolutional to analyze the significance of orbital volume calculation in predicting the probability or tendency of developing late enopthalmous on patients with unilateral orbital fracture with or without associated midface injury reported to our hospital. Materials and Methods: The subjects in our study included fifteen patients between18 and 60years. They were treated surgically and conservatively. Patients were exposed to series of examination from the day of injury or reporting for a consecutive period of up to six months following injury. CT was taken prior to treatment following management to evaluate the volume change in orbit. Its correlation and significance to treatment outcome were analyzed using MIMICS software by Materialise by comparing injured orbit to opposite side normal eye. Result: Conclusive of clinical examination and summary of statistical analysis patients were categorized into three groups: Low (with volume change of less than 2%), Medium (volume change between 2 to 20%) and High (volume change more than 20%) by comparing fractured orbit to uninjured orbit and a statistically significant mean value of 27.7 ± 2.6 cu.mm for fractures eye and 25.9 ± 2.6 cu.mm for normal eye was found ( P ≤≤ 0.05). Conclusion: Orbital volume can be considered as useful criteria in evaluation of patients with orbital fracture. Evaluation and follow up in correlation with resultant volume assessment provide a better indicator for assessment of prognosis and enopthalmous. Unlike other methods for volume assessment MIMICS software by Materialise provide a better method and it can be incorporated to working station in hospital. Every CT assessment in orbital trauma should include orbital volume as a parameter and this software is easy and user-friendly software that does not require its technical knowledge for application. [ABSTRACT FROM AUTHOR]

In this work, we present a photoplethy smography-based blood pressure monitoring algorithm (PPG-BPM) that solely requires a photoplethysmography (PPG) signal. The technology is based on pulse wave analysis (PWA) of PPG signals retrieved from different body locations to continuously estimate the systolic blood pressure (SBP) and the diastolic blood pressure (DBP). The proposed algorithm extracts morphological features from the PPG signal and maps them to SBP and DBP values using a multiple linear regression (MLR) model. The performance of the algorithm is evaluated on the publicly available Multiparameter Intelligent Monitoring in Intensive Care (MIMIC I) database. We utilize 28 data-sets (records) that contain both PPG and brachial arterial blood pressure (ABP) signals. The collected PPG and ABP signals are synchronized and divided into intervals of 30 seconds, called epochs. In total, we utilize 47153 clean 30-second epochs for the performance analysis. Out of the 28 data-sets, we use only 2 data-sets with a total of 2677 clean 30-second epochs to build the MLR model of the algorithm. For the SBP, a mean absolute error (MAE) of 6.10 mmHg between the arterial line and the PPG-based values are achieved, with a Pearson correlation coefficient r = 0.90, p =.001. For the DBP, and an MAE of 4.65 mmHg between the arterial line and the PPG-based values are achieved, with a Pearson correlation coefficient r = 0.85, p $\!<\!$.001. We also use a binary classifier for the BP values with the positives indicating SBP $\geq$ 130 mmHg and/or DBP $\geq$ 80 mmHg and the negatives indicating otherwise. The classifier results generated by the PPG-based SBP and DBP estimates achieve a sensitivity and a specificity of 79.11% and 92.37%, respectively. [ABSTRACT FROM AUTHOR]

Understanding and modeling the dynamics of human gaze behavior in 360° environments is crucial for creating, improving, and developing emerging virtual reality applications. However, recruiting human observers and acquiring enough data to analyze their behavior when exploring virtual environments requires complex hardware and software setups, and can be time-consuming. Being able to generate virtual observers can help overcome this limitation, and thus stands as an open problem in this medium. Particularly, generative adversarial approaches could alleviate this challenge by generating a large number of scanpaths that reproduce human behavior when observing new scenes, essentially mimicking virtual observers. However, existing methods for scanpath generation do not adequately predict realistic scanpaths for 360° images. We present ScanGAN360, a new generative adversarial approach to address this problem. We propose a novel loss function based on dynamic time warping and tailor our network to the specifics of 360° images. The quality of our generated scanpaths outperforms competing approaches by a large margin, and is almost on par with the human baseline. ScanGAN360 allows fast simulation of large numbers of virtual observers, whose behavior mimics real users, enabling a better understanding of gaze behavior, facilitating experimentation, and aiding novel applications in virtual reality and beyond. [ABSTRACT FROM AUTHOR]

Artificial gravity—it’s a concept you are probably already familiar with. According to Wikipedia, it is defined as “the creation of an inertial force that mimics the effects of a gravitational force.” The idea is that humans will have the ability, through technology or some superhuman/magical power, to create a gravitational field that mimics the pull of gravity that we feel while on Earth. Whether it’s on a futuristic spaceship, on a far-off planet, or in a fantasy world, being able to manipulate gravity gives humans an advantage and allows us to function anywhere in the universe as we would on Earth. [ABSTRACT FROM AUTHOR]

The primary objective in this article is to review common stroke mimic etiologies, as well as discuss the key historical and physical examination characteristics associated with stroke mimics, and to present a diagnostic framework for approaching such cases. [ABSTRACT FROM AUTHOR]

Abstract It was critical for the clinician to be aware of the neuroimaging and early‐onset symptoms of this fatal neurodegenerative disease, and avoid initiating inappropriate therapy. Neuroimaging plays a key role in differentiating it from other mimics.

Objective To assess whether the computed tomography (CT)‐based method of three‐dimensional (3D) analysis (Mimics) was accurate and reliable for spine surgical anatomical measurements. Methods A total of 40 lumbar segments and 32 inter‐vertebral discs from eigth adult male cadavers without fractures or deformities fixed with the classical formaldehyde method were included in this research on 5 June 2017. CT scans including seven dimensions: anterior height of the vertebral body (VBHa), middle height of the vertebral body (VBHm), posterior height of the vertebral body (VBHp), width of the upper endplate (EPWu), depth of the upper endplate (EPDu), anterior height of the inter‐vertebral disc in the median sagittal plane (IDHa), and posterior height of the inter‐vertebral disc in the median sagittal plane (IDHp). They were performed based on uniform conditions (slice thickness: 0.625 mm) using a CT scanner on 8 June 2017. Afterwards, the surgical anatomical measurements were conducted with a Vernier caliper on 12 June 2017. The computer‐aided anatomical measurements were conducted by three investigators using Mimics 16.0 to perform 3D reconstructions of CT bone on 16 June 2017. Finally, the length and angle were measured with associated measurement tools, yielding a verified accuracy of 0.01 mm and 0.01°, respectively. Each measurement was repeated three times, and all anatomical data was analyzed using the statistical software and P‐value 0.05) for lumbar vertebra measurements, and the absolute difference between surgical and computer‐aided data were all less than 1.0 mm (for the VBHa, VBHm, VBHp, EPWu, and EPDu were 0.12, 0.03, 0.03, 0.31, and 0.03 mm, respectively). Moreover, although the absolute differences of discs was larger than those of lumbar vertebras, no significant differences were detected between the computer‐aided and surgical anatomical measurements for the IDHa, as well as IDHp in the vast majority of measurements (P = 0.543, 0.079 or 0.052 for IDHa, and P = 0.212, 0.133 or 0.042 for IDHp). In addition, excellent reliability correlation was observed between the measurements of each investigator, and the reliability coefficients in the intra‐groups were all greater than 0.9 except for IDHp (reliability coefficient = 0.892). Additionally, the reliability coefficients were greater than 0.9 for the all between‐group correlations, and a significant correlation was also observed. Furthermore, no statistically significant difference for three anatomical values was found in the computer‐assisted measurements of the lumbar bone structure (P > 0.05). Similarly, we did not observe a statistical difference in the anatomical data of the lumbar discs from the three measures (P > 0.05). Conclusions Computer‐aided anatomical measurement for spine based on CT scans presents the high accuracy and reliability for improving spinal surgical procedures.

Abstract Background Stroke mimics account for up to one-third of acute stroke admissions and are a heterogeneous entity which pose diagnostic challenges. Diagnosing such patients is however crucial to avoid delays in treatment and potentially harmful medication prescription. We aimed at describing the magnitude, clinical characteristics and short-term outcomes of stroke mimics in patients clinically diagnosed with a stroke. Methods This prospective study enrolled patients admitted with a World Health Organization clinical criteria for stroke at a tertiary hospital in Tanzania. Baseline data was collected and the simplified version of the FABS scale was used to determine its usefulness in predicting stroke mimics. The National Institute of Health Stroke Scale and Modified Rankin Scale were used to assess for admission stroke severity and outcomes respectively. Results Among 363 patients with suspected stroke on admission, the final diagnosis was stroke mimics in 24 (6.6%) who had a mean age of 65.8 ± 15 years. Patients with stroke mimics were less likely to have cardiovascular risk factors for stroke including premorbid hypertension (7 (29.2%) vs 263 (77.6%), p

Abstract The human PXR (pregnane X receptor), a master regulator of drug metabolism, has essential roles in intestinal homeostasis and abrogating inflammation. Existing PXR ligands have substantial off‐target toxicity. Based on prior work that established microbial (indole) metabolites as PXR ligands, we proposed microbial metabolite mimicry as a novel strategy for drug discovery that allows exploiting previously unexplored parts of chemical space. Here, we report functionalized indole derivatives as first‐in‐class non‐cytotoxic PXR agonists as a proof of concept for microbial metabolite mimicry. The lead compound, FKK6 (Felix Kopp Kortagere 6), binds directly to PXR protein in solution, induces PXR‐specific target gene expression in cells, human organoids, and mice. FKK6 significantly represses pro‐inflammatory cytokine production cells and abrogates inflammation in mice expressing the human PXR gene. The development of FKK6 demonstrates for the first time that microbial metabolite mimicry is a viable strategy for drug discovery and opens the door to underexploited regions of chemical space.

ABSTRACT Mitochondria are dynamic organelles vital for energy production with now appreciated roles in immune defense. During microbial infection, mitochondria serve as signaling hubs to induce immune responses to counteract invading pathogens like viruses. Mitochondrial functions are central to a variety of antiviral responses including apoptosis and type I interferon signaling (IFN-I). While apoptosis and IFN-I mediated by mitochondrial antiviral signaling (MAVS) are well-established defenses, new dimensions of mitochondrial biology are emerging as battlefronts during viral infection. Increasingly, it has become apparent that mitochondria serve as reservoirs for distinct cues that trigger immune responses and that alterations in mitochondrial morphology may also tip infection outcomes. Furthermore, new data are foreshadowing pivotal roles for classic, homeostatic facets of this organelle as host-virus interfaces, namely, the tricarboxylic acid (TCA) cycle and electron transport chain (ETC) complexes like respiratory supercomplexes. Underscoring the importance of “housekeeping” mitochondrial activities in viral infection is the growing list of viral-encoded inhibitors including mimics derived from cellular genes that antagonize these functions. For example, virologs for ETC factors and several enzymes from the TCA cycle have been recently identified in DNA virus genomes and serve to pinpoint new vulnerabilities during infection. Here, we highlight recent advances for known antiviral functions associated with mitochondria as well as where the next battlegrounds may be based on viral effectors. Collectively, new methodology and mechanistic insights over the coming years will strengthen our understanding of how an ancient molecular truce continues to defend cells against viruses.

Lymphomas of the central nervous system (CNS) are broadly classified into primary CNS lymphoma (PCNSL) and secondary CNS lymphoma (SCNSL). PCNSL refers to lymphoma restricted to the brain, leptomeninges, spinal cord, or eyes without evidence of it outside the CNS at primary diagnosis, while SCNSL refers to secondary CNS involvement by systemic lymphoma. The brain is the most common site of involvement and intracranial CNS lymphoma has a highly variable imaging appearance and varies according to the patient’s clinical profile and immunity. This pictorial essay aims to illustrate the different facets of intracranial CNS lymphomas on neuroimaging. This enables radiologists to be familiarized with their key diagnostic features and differentiate from their differential diagnoses, leading to early diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

Kaposi sarcoma (KS) is a human herpes virus-8 (HHV8) – associated vasoformative lesion affecting the skin, mucosae, and viscera. Conventional cutaneous KS manifests with patch, plaque, or nodular lesions, with each subtype exhibiting distinctive histomorphology. Recent decades, however, have revealed a broader histological spectrum of KS in the skin. Recognition of the wide range of microscopic variants of KS and their individual mimics is essential for correct diagnosis. This is enhanced by careful clinico-pathological correlation and the utilisation of appropriate ancillary investigations. The demonstration of nuclear staining for HHV8 latency associated nuclear antigen by immunohistochemistry enables confirmation of a given KS variant. Conversely, negative immunoreactivity for HHV8 is a unifying feature among the numerous dermatoses and/or neoplasms that constitute the differential diagnosis of a given KS subtype. [ABSTRACT FROM AUTHOR]

Cohort selection is an essential prerequisite for clinical research, determining whether an individual satisfies given selection criteria. Previous works for cohort selection usually treated each selection criterion independently and ignored not only the meaning of each selection criterion but the relations among cohort selection criteria. To solve the problems above, we propose a novel unified machine reading comprehension (MRC) framework. In this MRC framework, we design simple rules to generate questions for each criterion from cohort selection guidelines and treat clues extracted by trigger words from patients' medical records as passages. A series of state-of-the-art MRC models based on BiDAF, BIMPM, BERT, BioBERT, NCBI-BERT, and RoBERTa are deployed to determine which question and passage pairs match. We also introduce a cross-criterion attention mechanism on representations of question and passage pairs to model relations among cohort selection criteria. Results on two datasets, that is, the dataset of the 2018 National NLP Clinical Challenge (N2C2) for cohort selection and a dataset from the MIMIC-III dataset, show that our NCBI-BERT MRC model with cross-criterion attention mechanism achieves the highest micro-averaged F1-score of 0.9070 on the N2C2 dataset and 0.8353 on the MIMIC-III dataset. It is competitive to the best system that relies on a large number of rules defined by medical experts on the N2C2 dataset. Comparing these two models, we find that the NCBI-BERT MRC model mainly performs worse on mathematical logic criteria. When using rules instead of the NCBI-BERT MRC model on some criteria regarding mathematical logic on the N2C2 dataset, we obtain a new benchmark with an F1-score of 0.9163, indicating that it is easy to integrate rules into MRC models for improvement. [ABSTRACT FROM AUTHOR]

Building a visual overview of temporal event sequences with an optimal level-of-detail (i.e. simplified but informative) is an ongoing challenge - expecting the user to zoom into every important aspect of the overview can lead to missing insights. We propose a technique to build a multilevel overview of event sequences, whose granularity can be transformed across sequence clusters (vertical level-of-detail) or longitudinally (horizontal level-of-detail), using hierarchical aggregation and a novel cluster data representation Align-Score-Simplify. By default, the overview shows an optimal number of sequence clusters obtained through the average silhouette width metric - then users are able to explore alternative optimal sequence clusterings. The vertical level-of-detail of the overview changes along with the number of clusters, whilst the horizontal level-of-detail refers to the level of summarization applied to each cluster representation. The proposed technique has been implemented into a visualization system called Sequence Cluster Explorer (Sequen-C) that allows multilevel and detail-on-demand exploration through three coordinated views, and the inspection of data attributes at cluster, unique sequence, and individual sequence level. We present two case studies using real-world datasets in the healthcare domain: CUREd and MIMIC-III; which demonstrate how the technique can aid users to obtain a summary of common and deviating pathways, and explore data attributes for selected patterns. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The anatomy of the posterior glottis, specifically the states of the posterior glottis during phonation, has not been thoroughly explored in laryngology. Conventional wisdom about the posterior glottis indicates that it tends to be completely closed in men but may be open in women. Furthermore, professional singers are expected to have a completely closed posterior glottis. The aim of this study was to investigate whether these generalizations are true by comparing rigid videolaryngostroboscopy results with high‐resolution computed tomography (HRCT) and three‐dimensional (3D) reconstruction findings. Study Design Prospective study. Methods: Of the 90 volunteers (58 women, 32 men) examined, 48 were female professional singers, 10 were female nonsingers, 22 were male professional singers, and 10 were male nonsingers. Rigid videolaryngostroboscopy as well as HRCT scans were performed during singing at the average singing fundamental frequency. HRCT images of the larynx and air‐column were 3D visualized using the software MIMICS®. The states of the posterior glottis were assessed in both examinations and compared among participants. Results: The sensitivity of endoscopy was 67.5%. Complete closure of the posterior glottis was observed in 62.5% men and 52% women (P =.33). Complete closure of the posterior glottis was observed in 35% nonsingers and 61% professional singers (P =.036). Conclusions: The closure of the posterior glottis seen on videolaryngostroboscopy does not always correlate with actual closure. There seems to be no link between sex and complete closure of the glottis. However, there is strong evidence that posterior glottis closure can be influenced, to some degree, by vocal training. Level of Evidence: 4 Laryngoscope, 132:124–129, 2022 [ABSTRACT FROM AUTHOR]

Proximal muscle weakness in children, as well as adults, can be the presenting feature of a wide range of diseases including but not limited to the idiopathic inflammatory myopathies, muscle dystrophies, metabolic, endocrine, and drug-induced myopathies. Certain diagnostic clues such as selective muscle involvement in inherited dystrophies, cramping on exertion in metabolic myopathies, diffuse muscular pain in endocrinal myopathies, and relevant drug history along with a lack of appropriate treatment response to steroids should be considered. Awareness of other possibilities and a keen eye to identify the mimics may avoid diagnostic delays and allow timely treatment. In this review, we cover some of the salient features of the various myositis mimics and the pertinent investigation findings as well as gray areas which may confound recognition of the underlying etiology. Later, we discuss key features of certain mimics while providing an overview of the differential diagnosis and clinical management for treating clinicians. [ABSTRACT FROM AUTHOR]